Job Description

JOB SUMMARY:

Under the direction of the Patient Financial Services Director, Financial Counselor is responsible for providing patients with a positive financial experience by helping patients navigate and understand insurance benefits and potential financial liability. Financial Counselors are the patient's point of contact for financial assistance questions. The Financial Counselor collects payments, sets up payment arrangements as appropriate, creates estimates, advises patients in person and over the phone on their insurance benefits and coverage, and in some cases, assesses patient referrals for appropriateness. The Financial Counselor assists patients with eligibility for government programs, Cibola General Hospital's financial assistance program, and other options for managing high medical liabilities.

PRIMARY FUNCTIONS:

1.Serves as the point of contact for all financial assistance related questions.

2.Communicates with patients to identify and understand financial, social, and medical histories and other relevant patient information

3.Gathers all relevant information required to process financial assistance requests; including but not limited to working with providers on treatment plans, best practices, and related necessary medical opinions.

4.Documents all communication and follow up in the EMR and send written confirmation to patient regarding payment arrangements, etc as applicable.

5.Assesses the current financial situation of patients through the verification of patient insurance benefits; serving as the technical expert in confirming patients benefit coverage and hospital reimbursement:

6.Determine the patient's financial ability to pay and explain insurance coverage and benefits to the patient. o

7.Initiate the financial screening process as appropriate to evaluate eligibility for assistance programs.

8.Assist the patient in completing financial statements and gathering supporting financial documentation. o

9.Complete the referral pattern for patients with financial risk

10.Determine eligibility for care at CGH by assessing patient eligibility for Medical Assistance, Emergency Medical Assistance, Community Programs, and Government Programs:

11.Assess and offer payment alternatives which may include prepayment for elective care,and applying for CGH's financial assistance program.

12.Identify eligible financial programming options and assist in completing all necessary documentation for specific federal, state, or CGH financial assistance programs

13.With provider involvement, determine urgency of scheduled care for patients with large financial liabilities resulting in either a decision to proceed, hold, reschedule, etc.

14.Explain CGH's payment policy to patients if a program is not available to assist with payment.

15.Calculate and explain any patient liability before or at the time of service.

16.Counsel patients on out of pocket liabilities and collect deductibles, pre-payments, and outstanding balances following established collection procedures; or alternatively, create a payment plan with the patient and document the agreement appropriately.

17.If unable to establish acceptable payment arrangements for elective procedures, inform provider and patient that services will be rescheduled or cancelled.

18.Communicate financial coverage status and applicable financial decisions with all appropriate parties: patient, family, referring clinicians, and CGH clinicians.

19.Assists with the maintenance of self pay accounts, initiates collection procedures when appropriate and sends out letters to patients regarding the status of the accounts; places accounts in the financial class needed before the account goes to collections if patients do not respond to calls and letters.

20.Pursues and participates in education opportunities to remain current with changes in the Healthcare industry

21.Promotes effective working relations and work effectively as part of a team to facilitate the department's ability to meet its goals and objectives.

22.Demonstrates respect and regard for the dignity of all patients, families, visitors, and fellow employees to insure a professional, responsible and courteous environment.

23.Attends on-site/off-site community engagement activities and on-site/off-site clinic events as needed.

24.Performs other duties as assigned.

EDUCATION / EXPERIENCE REQUIRED

1.High School Diploma / GED Required

2.Associate degree preferred.

3.Two years' experience in healthcare Revenue Cycle preferred.

4.Experience in providing high level of customer service.

5.Excellent organization and time management skills along with excellent oral and written communication skills.

6.Strong team player

7.Ability to learn quickly, build and maintain long term relationships and work with minimal supervision.

8.Proficient computing skills.

9.High-level of accuracy and attention to detail, flexibility, and ability to attend to competing priorities in an effective and timely way, and prioritize effectively in team environment.

KNOWLEDGE, SKILLS AND ABILITIES

1. Knowledge of medical billing/collection practices
2. Knowledge of computer programs
3. Knowledge of business office procedures
4. Knowledge of basic medical coding and third party operating procedures and practices
5. Ability to operate a computer, basic office equipment and a multi-line telephone system
6. Skill in answering a telephone in a pleasant and helpful manner
7. Ability to read, understand and follow both oral and written instructions
8. Ability to establish and maintain effective working relationships with patients, co-workers and the public
9. Must be well organized and detail-oriented

ADDITIONAL QUALIFICATIONS

1. Bilingual a plus (Spanish / English) preferred

RELATIONSHIP REPORTING

1. Reports to the PFS Supervisor

PHYSICAL REQUIREMENTS

1. Ability to sit, stand, walk or view a computer screen for extended periods of time
2. Ability to perform repetitive hand and wrist motions for extended periods of time

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